Hopelessness is associated with decreased heart rate variability during championship chess games

Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Training

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly "negative" processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.

Stress, Inflammation and Cancer Prognosis: New Evidence-Based Effective Treatments

This article introduces the general model of stress, coping and adaptation applied to cancer, and biological mechanisms mediating psychological factors and cancer prognosis. The role of the vagus nerve as a possible bridge and therapeutic target in psycho-oncology is reviewed. Finally, the effects of brief psychological interventions (e.g., stress management) on cancer prognosis are presented. Psycho-oncology education and practice need to shift to a more evidence-based proactive approach, to help cancer patients adapt and possibly improve their quality and quantity of life.

The salivary-α-amylase level after stroop test in anxious patients can predict the severity of anxiety

Individuals with anxiety disorder often exhibit as imbalance in response to stressors. We sought to explore the relationship between physiological as well as psychological responses under acute mental stress and the severity of the disease. 20 Generalized Anxiety Disorder (GAD) patients (14 males, mean age 46 ± 10 years) were confronted with the stroop test, during which salivary-α-amylase (sAA), salivary cortisol, and heart rate variability (HRV) were assessed. The results showed that stroop test as a stressor induced autonomic nervous response in GAD patients, which was mainly manifested as the increase in HRV representing sympathetic nervous system and the decrease in HRV representing vagal nerve activity. Moreover, the basic function of sympathetic-adrenal medulla system was hyperfunctional in GAD patients while theirs reactivity was limited, which showed the more serious the lesion was, the higher the baseline value of sAA was, and the less sAA secretion increase would be, or even decrease after mental stress. The change of sAA after stroop test in GAD patients can predict the severity of anxiety, but subjective psychological perception can not.

Feasibility of a culturally adapted positive psychological intervention for Hispanics/Latinos with elevated risk for cardiovascular disease

Although increasing emotional well-being has been proposed as a potential pathway to drive cardiac health, emotional well-being interventions for people with cardiac risk are underdeveloped, particularly among Hispanic/Latino adults. Our objective was to pilot a well-being intervention drawing on positive psychology concepts to determine feasibility and acceptability in Hispanics/Latinos at risk for cardiovascular disease (CVD). We developed a Spanish-language positive psychological intervention, with cultural tailoring informed by formative qualitative work, to promote emotional well-being and its antecedents in Hispanics/Latinos. Hispanic/Latino adults (n = 19) self-reporting two or more CVD risk factors were enrolled in our single-arm 8-week pilot trial. The group intervention consisted of 8 weekly 90-min sessions delivered by a bilingual licensed clinical social worker. Mean age was 54.1 years, 68.8% were female, and 50% had ≤eighth-grade education. Eleven of 19 Hispanic/Latino adults completed the 8-week program for a 57.89% retention rate, with a majority of factors leading to dropout unrelated to program content or mode of delivery. Most participants felt satisfied overall with each session (97.1%). Largest increases relative to baseline after receiving the intervention were found in engagement in happiness-inducing behaviors (e.g., meditation), emotional vitality, and subjective happiness using metrics of reliable change and effect sizes. This single-arm trial documented adequate feasibility and acceptability, although strategies to increase retention are warranted. Future studies should test our intervention using a randomized trial design with a larger sample size and inclusion of biomarkers (e.g., C-reactive protein) to document impact of our intervention on cardiac-related health.

High frequency heart rate variability: Evidence for a transdiagnostic association with suicide ideation

Low levels of high frequency heart rate variability (HF-HRV) have been shown to be associated with suicidal ideation and behavior in students and depressed patients. The goal of the present study was to examine associations between suicide ideation and resting HF-HRV as well as HF-HRV reactivity in a diagnostically heterogeneous sample of adult outpatients with or without concurrent suicide ideation. Participants were N = 85 outpatients (67.1% female; age: M = 38.8, SD = 13.72). HF-HRV reactivity was assessed using a sad film induction method. Associations between resting HF-HRV, HF-HRV reactivity and suicide ideation were analyzed using linear regression modeling - controlling for depression, anxiety and stress. HF-HRV reactivity towards the sad film, but not low resting HF-HRV baseline, was predictive of higher scores on suicidal ideation within the whole sample. In women, lower resting as well as perturbed HF-HRV reactivity was associated with higher scores on suicidal ideation. Results suggest that suicide ideators have a reduced capacity to regulate their response to stress.

Heart Rate Variability as a Marker of Distress and Recovery: The Effect of Brief Supportive Expressive Group Therapy With Mindfulness in Cancer Patients

Objectives. We aimed to investigate the effects of brief supportive expressive group therapy with mindfulness for cancer patients and to assess the utility of heart rate variability (HRV) as a biomarker of distress and treatment effect. Methods. A total of 28 female patients with nonmetastatic cancer at a university hospital in South Korea received a 4-week modified group therapy for distress reduction. The BESTMIND (Brief Expression and Support Therapy with Mindfulness) program consisted of supportive–expressive group therapy and mindfulness-based stress reduction. The subjective outcomes of distress, anger, sleep quality, and sense of well-being and the physiological outcome of HRV were assessed before and after the program. Results. After the program, patients showed significantly reduced distress, perceived stress, anger, and sleep disturbance and increased quality of life. No significant change was observed in the degree of mindfulness. A significantly increased SD in the normal beat-to-beat intervals and normalized high-frequency (HF 0.15-0.4 Hz) power from spectral analysis were observed after treatment. According to the correlation analyses, HF power correlated with depression scores, and normalized HF power was associated with depression, anxiety, perceived stress, and anger at baseline. The pretreatment and posttreatment comparison indicated that an increase in HF power was associated with a decrease in anger. Conclusions. These results suggest the effectiveness of this modified group-based program for distress reduction and also provide preliminary evidence for the use of HRV as a biomarker of distress and recovery. HF power from HRV variables may serve as a quantitative biomarker of the treatment response of distress management, including anger.

Cardiac vagal control as a marker of emotion regulation in healthy adults: A review

In the last two decades, a growing body of theory and research has targeted the role of cardiac vagal control (CVC) in emotional responding. This research has either focused on resting CVC (also denoted as cardiac vagal tone) or phasic changes in CVC (also denoted as vagal reactivity) in response to affective stimuli. The present paper is aimed at reporting a review of the papers published between 1996 and 2016, and focused on the results of 135 papers examining cardiac vagal control as a physiological marker of emotion regulation in healthy adults. The review shows that studies have employed a wide array of methodologies and measures, often leading to conflicting results. High resting CVC has been associated with better down-regulation of negative affect, use of adaptive regulatory strategies, and more flexible emotional responding. Concerning phasic changes, research has consistently found decreased CVC in response to stress, while CVC increases have been shown to reflect either self-regulatory efforts or recovery from stress. Despite conflicting results, we conclude that existing literature supports the use of CVC as a noninvasive, objective marker of emotion regulation.

Vagal nerve activity predicts overall survival in metastatic pancreatic cancer, mediated by inflammation

Recent research findings suggest neuro-modulation of tumors. Finding new modifiable prognostic factors paves the way for additional treatments, which is crucial in advanced cancer, particularly pancreatic cancer. This study examined the relationship between vagal nerve activity, indexed by heart rate variability (HRV), and overall survival (OS) in patients (N=272) with advanced pancreatic cancer. A "historical prospective" design was employed, where vagal activity and other confounders were retroactively obtained from medical charts at diagnosis, and subsequent OS was examined. HRV was obtained from 10 sec ECGs near diagnosis. Levels of C-reactive protein (CRP) were measured as an inflammatory marker. OS and survival date were obtained from medical charts and the Belgian national registry. Patients with high HRV (>20 msec) survived on average more than double the days (133.5) than those with low HRV (64.0). In a multivariate cox regression, higher initial HRV was significantly correlated with lower risk of death, independent of confounders including age and cancer treatments. This relationship was statistically mediated (accounted for) by CRP levels. Importantly, in patients who lived up to one month from diagnosis only, HRV was unrelated to CRP, while in patients surviving longer, HRV was significantly inversely related to CRP (r=-0.20, p<0.05). These results are in line with possible vagal nerve protection in a fatal cancer, and propose that the mechanism may involve neuroimmuno-modulation. Future studies must test whether vagal nerve activation may help patients with advanced cancers.

Complexity of physiological responses decreases in high-stress musical performance

For musicians, performing in front of an audience can cause considerable apprehension; indeed, performance anxiety is felt throughout the profession, with wide ranging symptoms arising irrespective of age, skill level and amount of practice. A key indicator of stress is frequency-specific fluctuations in the dynamics of heart rate known as heart rate variability (HRV). Recent developments in sensor technology have made possible the measurement of physiological parameters reflecting HRV non-invasively and outside of the laboratory, opening research avenues for real-time performer feedback to help improve stress management. However, the study of stress using standard algorithms has led to conflicting and inconsistent results. Here, we present an innovative and rigorous approach which combines: (i) a controlled and repeatable experiment in which the physiological response of an expert musician was evaluated in a low-stress performance and a high-stress recital for an audience of 400 people, (ii) a piece of music with varying physical and cognitive demands, and (iii) dynamic stress level assessment with standard and state-of-the-art HRV analysis algorithms such as those within the domain of complexity science which account for higher order stress signatures. We show that this offers new scope for interpreting the autonomic nervous system response to stress in real-world scenarios, with the evolution of stress levels being consistent with the difficulty of the music being played, superimposed on the stress caused by performing in front of an audience. For an emerging class of algorithms that can analyse HRV independent of absolute data scaling, it is shown that complexity science performs a more accurate assessment of average stress levels, thus providing greater insight into the degree of physiological change experienced by musicians when performing in public.

Heart rate variability and pre-competitive anxiety in BMX discipline

Altered neural mechanisms implying autonomic functioning have been described related to anxiety. Pre-competitive stress may be considered as an anxiety-state associated with disorders (i.e. somatic and cognitive alterations, and self-confidence worsening) that severely impair sport performance, conditioning short-lasting strength-related disciplines like BMX. From the psychological perspective, coaches use questionnaires like CSAI-2R to identify these alterations. However, with the emergence of psycho-physiological and non-linear approaches, recent studies suggest that HRV analysis provides a non-invasive tool to assess them. Hence, our purpose was to analyze how BMX competition affects subjective perception of anxiety, and if this emotional alteration is reflected in HR dynamics, analyzed both linear and nonlinearly, exploring the evolution of this relationship in a 2-day competition. Eleven male athletes from the BMX Spanish National Team were assessed from baseline HRV the morning of a training session (rT) and on two successive days of competition (rC1 and rC2), repeating HRV recording with CSAI-2R 20 min prior to training (aT) and competition (pre-competitive: aC1 and aC2). Repeated measures MANOVA showed significant vagal slow-down responses in aC1 and aC2 comparing not only with aT, but also comparing with rT, rC1 and rC2, coinciding with significant greater scores for the somatic and cognitive anxiety (SA and CA) in aC1 and aC2 versus aT. Pearson analysis showed a large and positive correlation between α1 and SA in C1, and close to it between SampEn and CA in aC2; both were confirmed by Bland-Altman chart analysis. Our results confirm that HRV analysis provide a complementary tool to assess competitive pressure.

Novelty-evoked activity in open field predicts susceptibility to helpless behavior

Learned helplessness in animals has been used to model disorders such as depression and post-traumatic stress disorder (PTSD), but there is a lack of knowledge concerning which individual behavioral characteristics at baseline can predict helpless behavior after exposure to inescapable stress. The first aim of this study was to determine behavioral predictors of helplessness using the novel and familiar open-field tests, sucrose consumption, and passive harm-avoidance tasks before learned helplessness training and testing. Individual differences in physiologic responses to restraint stress were also assessed. A cluster analysis of escape latencies from helplessness testing supported the division of the sample population of Holtzman rats into approximately 50% helpless and 50% non-helpless. Linear regression analyses further revealed that increased reactivity to the novel environment, but not general activity or habituation, predicted susceptibility to learned helplessness. During restraint stress there were no mean differences in heart rate, heart rate variability, and plasma corticosterone between helpless and non-helpless rats; however, a lower heart rate during stress was associated with higher activity levels during exploration. Our most important finding was that by using an innocuous screening tool such as the novel and familiar open-field tests, it was possible to identify subjects that were susceptible to learned helplessness.

Engel's biopsychosocial model is still relevant today

In 1977, Engel published the seminal paper, "The Need for a New Medical Model: A Challenge for Biomedicine" [Science 196 (1977) 129-136]. He featured a biopsychosocial (BPS) model based on systems theory and on the hierarchical organization of organisms. In this essay, the model is extended by the introduction of semiotics and constructivism. Semiotics provides the language which allows to describe the relationships between the individual and his environment. Constructivism explains how an organism perceives his environment. The impact of the BPS model on research, medical education, and application in the practice of medicine is discussed.

The stress of chess players as a model to study the effects of psychological stimuli on physiological responses: an example of substrate oxidation and heart rate variability in man

We have studied the physiological consequences of the tension caused by playing chess in 20 male chess players, by following heart rate, heart rate variability, and respiratory variables. We observed significant increase in the heart rate (75-86 beats/min), in the ratio low frequency (LF)/high frequency (HF) of heart rate variability (1.3-3.0) and also a decrease in mean heart rate variability with no changes in HF throughout the game. These results suggest a stimulation of the sympathetic nervous system with no changes in the parasympathetic system. The respiratory exchange ratio was rather elevated (over 0.89) at the start and significantly decreased during the game (0.75 at the end), indicating that energy expenditure progressively switched from carbohydrate to lipid oxidation. The changes in substrate oxidation and the sympathetic system seem to be due to high cognitive demands and bring new insight into adaptations to mental strain.

Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

Self-Esteem and Autonomic Physiology: Parallels Between Self-Esteem and Cardiac Vagal Tone as Buffers of Threat

In this article a potential physiological connection to self-esteem is suggested: cardiac vagal tone, the degree of influence on the heart by the vagus, a primary nerve of the parasympathetic nervous system. This hypothesis emerges from parallels between the two literatures that suggest both self-esteem and cardiac vagal tone function to provide protection from threat responding. This article reviews these literatures and evidence and preliminary findings that suggest in some contexts self-esteem and cardiac vagal tone may exert an influence on each other. Last, the article discusses theoretical and applied health implications of this potential physiological connection to self-esteem.

Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents

OBJECTIVE

We investigated the relative effects of fatigue, depressive symptoms, and hopelessness on prognosis at 2-year follow-up in percutaneous coronary intervention (PCI) patients.

METHODS

Consecutively admitted PCI patients (n=534) treated with paclitaxel-eluting stent as the default strategy completed the Maastricht Questionnaire (MQ) at baseline. Apart from an overall vital exhaustion score, the MQ also assesses fatigue (seven items; Cronbach's alpha=.87) and depressive symptoms (seven items; Cronbach's alpha=.83), with hopelessness (one item) comprised in the depressive symptom items. Patients were followed up for adverse clinical events (mortality and nonfatal myocardial infarction) at 2 years.

RESULTS

At 2-year follow-up, there were 31 clinical events. In univariable analyses, overall vital exhaustion and depressive symptoms, but not fatigue, were associated with adverse prognosis; in multivariable analysis, depressive symptoms [hazard ratio (HR)=2.69; 95% confidence interval (95% CI)=1.31-5.55] remained the only predictor of clinical outcome. Among the depressive symptoms, hopelessness (HR=3.44; 95% CI=1.65-7.19) was the most cardiotoxic symptom. The incidence of clinical events was higher in the high-hopelessness patients (11% vs. 3%; P=.001) than in the low-hopelessness patients. Hopelessness (HR=3.36; 95% CI=1.58-7.14; P=.002) remained an independent predictor of clinical outcome at 2 years in adjusted analysis.

CONCLUSION

Symptoms of depression, but not fatigue, predicted adverse clinical events. Hopelessness was the most cardiotoxic symptom, associated with a more than three-fold risk of clinical events 2 years post-PCI. Screening for hopelessness may lead to the identification of high-risk patients.

Relations between psychometric profiles and cardiovascular autonomic regulation in physical education students

This study was designed to investigate physical education (PE) students the link between mood disturbances, caused by psychological or physical stressors associated with studying, and the autonomic nervous system modifications. PE students completed the profile of mood state (POMS) questionnaire at the end of the university year. Heart rate variability (HRV) was then measured during a head-up tilt test (HUT) in those with the highest and lowest total mood disturbance (TMD) scores on three successive POMS. Among the 218 students who completed the POMS (85 female and 137 male), 65 had high TMD scores, suggesting mood disturbances and fatigue. The final sample included 12 subjects in the potentially overtrained (POT) group and 16 subjects in the control (CTL) group. A greater decrease of two indices of the autonomic system (SD1 and RMSSD) was observed during the HUT in the POT than in the CTL group (P < 0.05). The depression (Dep) and vigor (Vig) subscales of POMS were correlated with several HRV indices. More specifically, in the POT group, the Vig score was correlated with autonomous activity in the supine position, and the Dep score with percentages of change of sympatho-vagal activity during the HUT. This suggests that (1) POT students could present a weaker autonomic response to HUT, (2) Dep and Vig subscales of the POMS questionnaire may indicate autonomic dysregulations.

A complete database of international chess players and chess performance ratings for varied longitudinal studies

Chess is an oft-used study domain in psychology and artificial intelligence because it is well defined, its performance rating systems allow ea sy identification o f experts and their development, andchess playing is a complex intellectual task However, usable computerized chess data have been very limited. The present article has two aims. The first is to highlight the methodological value of chess data and how researchers can use them to address questions in quite different areas. The second is to present a computerized database of all international chess players and official performance ratings beginning from the inaugural 1970 international rating list. The database has millions of records and gives complete longitudinal official performance data for over 60,000 players from 1970 to the present. Like a time series of population censuses, these data can be used for many different research and teaching purposes. Three quite different studies, conducted by the author using the database, are described.

Implementation and interpretation of respiratory sinus arrhythmia measures in psychosomatic medicine: practice against better evidence?

Respiratory sinus arrhythmia (RSA) or high-frequency heart rate variability has been widely used as a noninvasive measure of cardiac vagal tone. However, their dependency on both respiration rate and tidal volume is largely ignored. Only a minority of studies published in Psychosomatic Medicine in recent years has implemented precautions for controlling respiration rate in RSA measures, and tidal volume effects were only rarely addressed. We discuss methodologic issues related to respiratory control methods and present data that demonstrate that both respiration rate and tidal volume contribute substantially to the within-individual RSA variance under conditions of variable breathing, with tidal volume contributing up to one third beyond respiration rate. Finally, we outline a respiratory control method for the time-domain index of RSA and review research pertaining to its reliability, validity, and experimental application.

Therapeutic modulation of the psychoneuroimmune system by medical acupuncture creates enhanced feelings of well-being

PURPOSE

This article includes an explanation of how stressors disrupt physiologic regulatory mechanisms leading to disease states, how environmental challenges alter the function of the psychoneuroimmune system, and how correction of aberrant action potentials will stabilize homeostatic regulatory functions, inducing an escape response from stressors and leading to enhanced feelings of well-being. An explanation of how medical acupuncture accomplishes this stabilization concludes the article.

DATA SOURCE

Extensive review of the worldwide scientific literature from the 1970s through current literature, on acupuncture, neurophysiology, and psychoneuroimmune system, using the theoretical framework of Martha Rogers.

CONCLUSIONS

It is estimated that 80% of all illnesses are stress induced, although the physiologic mechanisms by which stress induces detrimental changes are not well understood by the medical profession. Introducing specific rhythmic electrical impulses slightly more intense than the nervous system already generates with the intervention of medical acupuncture can therapeutically alter aberrant signals induced by stressors, which may result in the release of neuropeptides and stabilization of homeostatic regulation so that health outcomes are improved. As neurological activity is altered, the firing pattern of nerves is changed. This is a change in the electrical pattern that leads to a change in the biochemical pattern. Thus, medical acupuncture is a therapy that is in agreement with Martha Rogers' conceptual model. Therapeutic techniques may improve the individual's level of wellness by direct actions toward homeostatic stabilization of the autonomic nervous system. These techniques will not change the amount of stressors a person is subject to but will change the physiological response to them. When the nervous system is in homeostatic balance, individuals will report enhanced feelings of well-being, be more effective in coping with their conditions of living, and therefore be less susceptible to illness.

IMPLICATIONS FOR PRACTICE

Nurse practitioners have an opportunity to expand into an unused dimension for nursing care through direct treatment of the central and autonomic nervous system that will influence the psychoneuroimmune system. A prescriptive theory explaining medical acupuncture provides for therapeutic interventions at the primary, secondary, and tertiary level of care. Primary preventive interventions alter the effects of stress before it leads to illness by assisting homeostatic stability of the autonomic nervous system. Secondary interventions allow treatment of many health conditions regulated by neurological activity. Tertiary care provides a method to assist autonomic regulation when the body is no longer able to maintain homeostatic stability because of chronic illness or injury.

Psychosocial stress and cardiovascular diseases

Fifty five years after the first finding relating mood disturbances and cardiovascular diseases, there is still debate on the formation of a cogent conception embracing all the fragments of insight within the various aspects relating psychosocial stress to cardiovascular diseases. The clinical comorbidity is empirically evident, but there are ambiguous research results limiting the value of the proposed pathophysiological mechanisms. Psychosocial stress represents here any event that relates psychological phenomena to the social environment and to the associated pathophysiological changes. Stress denotes the external or environmental factors to which people are exposed, as well as the behavioural or biological reaction to it (response that some authors call "distress"). Cardiovascular diseases will be considered here only when being the consequence of chronic inflammatory disease of arteries (atherosclerosis). The question is: are there pathophysiological reliable mechanisms relating psychosocial stress to the development of cardiovascular diseases?

Negative affect states and cardiovascular disorders: a review and the proposal of a unifying biopsychosocial concept

AIM

The purpose of this review was to study the relationships between negative affect states and cardiovascular disorders.

PROCEDURE

The phenomenology of the negative affect states of depression, helplessness, hopelessness, vital exhaustion and grief is described. Their correlations with morbidity and mortality are analyzed. The physiological correlates of the affect states are pointed out. Finally, the reaction pattern of conservation-withdrawal according to Schmale and Engel and its ontogenesis are outlined. This is a disengaging behavior pattern as opposed to the engaging fight-flight reaction pattern of Cannon. The giving up complex, with its affects of helplessness and hopelessness, is explained.

CONCLUSIONS

The giving up complex in the context of the conservation-withdrawal pattern presents a biologically and developmentally sound conceptual basis for the understanding of the relationships of the negative affect states with cardiovascular disorders. This enables the integration of the concept of vital exhaustion, which has become the most promising operationalized instrument in psychosocial cardiovascular research.